antidepressants

What are antidepressants?

Antidepressants are psychiatric drugs that are used for the treatment and prevention of depression and several other mental health conditions.

As a prescribed medication, they are only legally obtainable on prescription following a clinical diagnosis.

Antidepressants are also commonly used to treat other mental health conditions and illnesses, including:

Generalised Anxiety Disorder – GAD

Obsessive-Compulsive Disorder – OCD

Post Traumatic Stress Disorder – PTSD

Some antidepressants can also work to reduce chronic neuropathic pain; Amitriptyline is often prescribed for this purpose.

Antidepressants usually come in pill or capsule form to be administered daily, and dosages for each different medication vary.

In patients with very severe depressive disorders who are likely to forget to take their medication, a depot injection (long-acting and slow release of medication) is administered by a mental health specialist or nurse.

How long do antidepressants take to work? 

Antidepressants work well in relieving the symptoms of anxiety and depression relatively quickly (2 to 4 weeks); however, their full benefits can take up to three months to be felt.

Some of the more potent types of antidepressants can work within days to relieve some of the more distressing symptoms of depression.

Treatment is usually recommended for a minimum of 6 months of stabilisation, after which a patient should be weaned off the medication under the supervision of their GP to avoid a recurrence of symptoms.

The initial relief of symptoms of depression that antidepressants provide enables the sufferer to work through the causes of their illness with a professional counsellor or therapist. 

Antidepressants work by changing the brain’s chemistry. The neurotransmitters affected by antidepressants tend to be serotonin and noradrenaline. The brain naturally produces serotonin as an organic feel-good chemical. In some people, there is a lack of serotonin which leads to low mood and anxiety. 3

Types of antidepressants

There are numerous types of medications available, each belonging to specific groups that work in different ways.

Names of antidepressants that are prescribed are:

SSRI Antidepressants

Selective serotonin reuptake inhibitors

SSRIs tend to be the preferred choice for prescribing in the UK and are the most commonly prescribed antidepressant; they have fewer side effects than the other types.

SSRIs are less likely to be abused as they work over a longer period of time. Overdoses are also less likely to be life-threatening. SSRIs also have the added benefit of causing fewer and less serious side effects.

Examples of SSRI  include Fluoxetine (Prozac), citalopram (Cipramil) and sertraline (Lustral)

SNRI Antidepressants

Serotonin-noradrenaline reuptake inhibitors

SNRIs are very similar to SSRIs. For some individuals with depressive disorders, they will respond better to SNRI antidepressants than SSRIs.

SNRIs are also widely prescribed and include Duloxetine and Venlafaxine.

NASSA Antidepressants

Noradrenaline and specific serotonergic antidepressants

NASSAs may be more effective for people who are unable to tolerate SSRIs. NASSAs are also thought to cause fewer sexual problems as a potential side effect. Unfortunately, this is a common problem for those who take SSRIs.

The most commonly prescribed NASSA in the UK is Mirtazapine, which can cause drowsiness and therefore has abuse and overdose potential.

TCA Antidepressants

Tricyclic antidepressants

TCAs used to be commonly prescribed before SSRIs were developed. Now they are considered more outdated.

TCAs tend to cause more unpleasant side effects and are more dangerous if overdosed on.

TCAs are usually prescribed for those that do not respond to SSRIs or SNRIs. TCAs may also be clinically recommended for those that suffer from specific depressive disorders such as OCD or bipolar.

Amitriptyline, a TCA, can also be prescribed to treat chronic nerve pain.

Examples of TCAs are Amitriptyline, Imipramine (Tofranil)

MAOI Antidepressants

Monoamine oxidase inhibitors

MAOIs are rarely prescribed these days due to potentially serious side effects. They also interact negatively with many other medications.

An MAOI antidepressant is only usually prescribed to patients that have been resistant to other treatments and would only be prescribed by a psychiatrist or mental health consultant.

Examples of MAOIs include tranylcypromine and isocarboxazid.

How can antidepressants help?

If you have clinical depression, you can experience:

  • Depressed mood, distinguished by sadness, hopelessness. 
  • Distinct lack of interest or pleasure in all or almost all activities.  
  • Notable weight loss when not dieting 
  • Inability to sleep or oversleeping
  • Anxiety and unfocused uneasiness
  • Lethargy or loss of energy 
  • Repeated suicidal thoughts

If you take antidepressants, they can help to lift your mood. This can allow you to feel more able to do things that didn’t feel possible while you were depressed. 

Antidepressants and Alcohol

antidepressants and alcohol

Mixing alcohol with antidepressants is never a good idea. Alcohol is a depressant and prevents antidepressants from working as they should.

A depressed individual who drinks alcohol to ‘self medicate’ is also more prone to developing a problem with drinking. This is why it is strongly recommended not to consume alcohol whilst undergoing treatment for depression.

Antidepressant side effects

side effects of antidepressants

Depending on the drug prescribed, there will be a list of possible side effects associated with that specific medication.

Side effects tend to be more pronounced during the first few weeks of treatment. For an individual suffering, some side effects can be very distressing and difficult to cope with.

One of the more dangerous side effects commonly associated with first beginning a course of medication is increased suicidal thoughts. This is why antidepressants should only be prescribed following a comprehensive assessment by a doctor or psychiatrist. Very close monitoring and support will be needed in the early weeks of treatment.

Common side effects of antidepressants include:

  • Increased anxiety
  • Brain fog
  • Nausea
  • Dizziness
  • Stomach upset and diarrhoea
  • Headaches
  • Insomnia
  • Poor concentration
  • Drowsiness
  • Confusion
  • Suicidal ideation and increased self-harm urges
  • Erratic emotions and severe mood swings
  • Feelings of emotional numbness
  • Tremors
  • Blood pressure changes
  • Appetite changes
  • Weight gain/loss
  • Loss of sexual libido
  • Sexual dysfunction
  • Increased yawning
  • Distressing thoughts
  • Vivid dreaming and nightmares

There are many more possible side effects of antidepressants. Any troublesome or persistent side effects should be discussed with your prescriber immediately.

Are Antidepressants addictive?

You may feel as though you are addicted to an antidepressant, but it’s not completely the same as being addicted to some other drugs. You will not get the cravings or feeling the need to continually increase the dose that you take. This is unlike some other substances like alcohol, nicotine or benzodiazepines. But it can still be tough to stop taking an antidepressant.

If you or a loved one are planning on coming off antidepressants, you should discuss this with a doctor and not just abruptly stop taking the medication.

Certain antidepressants can be more difficult to stop than others and have more severe withdrawal symptoms.

Ideally, after a course of medication has been completed and a patient’s condition stabilised for at least 6 months, with the help of medical advice, the medication can gradually be tapered off. Weaning off process is vital to prevent the illness from recurring and to minimise withdrawal symptoms.

Antidepressant withdrawal symptoms include:

  • Increased anxiety
  • Low mood
  • Insomnia and sleep problems
  • Changes in appetite
  • Severe mood swings
  • Rebound depression
  • Poor impulse control
  • Nausea
  • Gastric problems
  • Headaches
  • Suicidal thoughts
  • Erratic behaviour
  • Tremors

Depending on the antidepressant being stopped and the dosage, withdrawal symptoms can vary tremendously.

Some people will have little, or no trouble in stopping their medication whilst others will experience very severe and distressing symptoms.

Stopping an antidepressant gradually with the help and support of a psychiatrist vastly decreases the chances of developing the more severe symptoms of withdrawal.

From 2017 to 2018, antidepressants were one of the five named groups of addictive prescribed drugs that came under a landmark review by Public Health England. 

The review followed findings that 17% of the adult population were currently receiving a prescription of antidepressant medication. 1

Alternatives to antidepressants

herbal antidepressants

According to data collected by the Royal College of Psychiatrists, 50 to 65% of people treated with an antidepressant for depression will see a marked improvement, compared to 35 to 30% of people taking a placebo pill. This goes to show that they are not effective for everyone and that belief and trust in treatment is just as important to the person being treated. 2

Depending on the severity of a person’s depression, safer alternatives to antidepressant medications should be considered.

In cases of severe clinical depression, a person is often unable to engage in holistic treatments; initially, this is where medical treatment is needed first to alleviate depression symptoms.

Antidepressants do not suit everyone, nor do they work for everyone. Some people prefer to take a more holistic approach to heal. Many individuals benefit from combining traditional medicines with holistic treatments.

Proven holistic treatments that have been shown to work in improving the symptoms of depression and anxiety include CBT based talking therapies, life coaching, exercise, good nutrition and diet, sleep hygiene, mindfulness and meditation.

Some people look to herbs and natural remedies to find relief from their symptoms. Several herbs may help lift your mood; Zinc, Omega-3 fatty acids and Saffron. If you do decide to use herbal antidepressants, always check with a physician first to make certain they won’t interact with any medication you might be taking.

There can be many causes of an individual developing depression or anxiety; a lifestyle overhaul can often work wonders in improving the symptoms of mild to moderate depression.

Antidepressants and substance misuse – dual diagnosis patients

It very common for those with an alcohol or drug problem to also suffer from severe anxiety and depression.

General practitioners often misunderstand addiction and prescribe antidepressants hoping the individual will stop the substance abuse.

Addiction is a chronic and progressive disease of the brain that responds to very specific support and treatment.

To correctly diagnose any mental health condition, the substance(s) must first of all, be safely removed from the equation. Often, this requires a full medical detox.

Only once an individual is sober and clean and free from the fog of detoxification can a correct diagnosis of any remaining mental health illnesses be made and treated appropriately.

CQC registered rehab centres are proficient in treating patients presenting with a dual diagnosis. They treat all illnesses and addictions presenting simultaneously, within the same treatment episode. This vastly reduces the chances of relapse.

For more information on private dual diagnosis treatment programmes, call and speak with one of our friendly addiction treatment experts today.

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References:

  1. https://www.gov.uk/government/publications/prescribed-medicines-review-report/prescribed-medicines-review-summary
  2. https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/position-statements/ps04_19—antidepressants-and-depression.pdf?sfvrsn=ddea9473_5
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025168/

 

 

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